Buprenorphine Prescribing: To Expand or Not to Expand

Abstract

As a result of the prescription opioid epidemic in the United States, there has been an increasing need for effective treatment interventions, both pharmacologic and non-pharmacologic. Buprenorphine has emerged as a critical component of the treatment of opioid use disorder, yet its adoption has not been without some concerns. This article first reviews the pharmacology, clinical use, and US legislative action related to buprenorphine, followed by a discussion of the misuse and diversion of buprenorphine in the United States as well as internationally. We then explore the impact of buprenorphine abuse as well as discussing strategies for its reduction, including changes in policy, prescription and pharmacy monitoring, and continuing medical education for guiding and improving clinical practice.

Buprenorphine-based opioid substitution therapy in India: A few observations, thoughts, and opinions

“…It is how to expand buprenorphine prescribing safely and effectively,” as asserted by Li et al . [ 54 ]…”

Increasing rates of buprenorphine diversion in the United States, 2002 to 2019

“…7 Such concerns influenced regulations designed to limit buprenorphine prescribing capacity among physicians. 8 Although prescribing rules were relaxed as a result of the COVID-19 pandemic, 9 limitations on prescribing may contribute to diversion and non-medical use among individuals who do not have adequate access to prescribed buprenorphine. 10,11 Indeed, data from large studies of individuals in treatment for OUD, indicate that the use of diverted buprenorphine generally coheres with intended therapeutic use, including managing withdrawal symptoms, remaining abstinent, and weaning oneself off of opioids.…”

Primary care for opioid use disorder

“…Nonetheless, concerns remain about the ability of busy primary care settings to manage problem opioid users along with other patients. In particular, proposed extensions of buprenorphine treatment, a critically effective intervention for opioid use disorder (OUD), are cautiously considered due to the potential risk of misuse or abuse 2. General practitioners are already facing this burden daily in the treatment of chronic pain, and expert supervision and treatment model adjustment are needed to help improve outcomes.…”

“…In particular, proposed extensions of buprenorphine treatment, a critically effective intervention for opioid use disorder (OUD), are cautiously considered due to the potential risk of misuse or abuse. 2 General practitioners are already facing this burden daily in the treatment of chronic pain, and expert supervision and treatment model adjustment are needed to help improve outcomes. Approximately 20% of patients in primary care have noncancer pain symptoms, with most of them receiving opioid prescriptions by their physicians, and their number is increasing.…”

“…In some areas of the US, there are less than three prescribers per 100,000 persons, the average number of patients for certified prescribers is only one-quarter of the current limit of 100, and one-quarter of physicians with a waiver have never prescribed the medication. 2 …”